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Peyronie's Disease: Causes and Treatment

Why does my penis have a bend in it when it's erect?

Many men have a slight curve in their penis, so if you've always been this way, it's probably normal for you. But if it's a change you recently noticed, see your doctor. You may have Peyronie's disease, a condition in which thick scar tissue forms in the penis so that it contracts on one side and bends up, down, or to the side when hard. This problem, which can make erections painful and intercourse difficult or impossible, may affect up to 1 percent of men, most of them between the ages of 45 and 60. Nearly a third of these men have similar scar tissue in their hands and other parts of their bodies.

What causes Peyronie's disease?

Experts don't exactly know. Some men have developed the problem after having prostate surgery -- however, the percentage of men in this case is very small. By no means should you avoid having necessary surgery because of concerns about Peyronie's disease. Some experts speculate that the scarring may result from physical trauma -- an injury to the penis from having a catheter inserted for surgery or from sudden, forceful bending during sex. Others suggest that an abnormality in some men's collagen, a protein that helps build tissue, may lead to the condition.

What can I do about it?

Often the problem goes away on its own within a few months to a year and the penis returns to its original shape. In the meantime, experiment with your partner to find ways of making sex comfortable and resist getting too acrobatic. If you're having pain or difficulty maintaining an erection, see your doctor. He or she may try to break up the collagen in the scar tissue by injecting drugs such as collagenase, calcium channel blockers, or interferons directly into the lump. But none of these methods has been tested in controlled studies, so no one knows if they really work. Injecting cortisone-like drugs into the scar tissue rarely resolves the problem and can cause further injury.

If the disease is in its early stages -- the first 12 to 18 months -- oral medications like colchicine, potassium aminobenzoate (Potaba) or even vitamin E may help. (Don't take large doses of vitamin E without checking with your doctor, however, as it can be unsafe.)

If the problem persists, some doctors recommend surgery. But because surgery isn't foolproof and may cause further problems, most experts recommend waiting a year or two to give your body time to heal itself.

What's the surgery like?

Most commonly, the surgeon removes the hardened scar tissue and replaces it with a patch of skin from your groin. Other methods involve removing or pinching the penile tissue on the side opposite the scar tissue to counteract the bending; another approach is to cut into the scar to allow the penis to straighten. In some cases, the doctor will insert a prosthesis into the penis to straighten it. The prosthesis may be a semi-rigid rubber or silicone rod placed inside the shaft of the penis, or it may consist of two inflatable tubes implanted under the skin on either side of the penis that can be filled with air using a small hand pump to create an erection.

Unfortunately, surgery can't fix everything. The formation of a hardened scar usually shortens the penis, a symptom that many men view with distress. Surgery can't restore the penis to its original length and may even shorten it further -- another reason most experts suggest giving the body time to heal itself.

References

Peyronie's disease. MayoClinic.com. August 31, 2007.

National Kidney and Urologic Diseases Information Clearinghouse. Peyronie's Disease. September 2005.

Peyronie's Disease and Radical Prostatectomy: Is There a Link? Johns Hopkins Medical Institutions Department of Urology. Vol 5. No 1. Winter 2000.

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